title: Long-term trends in incidence, survival and mortality of primary penile cancer in England.
abstract: OBJECTIVE
  Few population-based studies exist of long-term trends in penile cancer. We report incidence and mortality trends in England over the 31 years 1979-2009 and survival trends over the 40 years 1971-2010.
  
  
  METHODS
  We calculated annual incidence and mortality rates per 100,000 by age and calendar period. We estimated incidence and mortality rate ratios for cohorts born since 1890, and one- and five-year relative survival (%) by age and deprivation category.
  
  
  RESULTS
  A total of 9,690 men were diagnosed with penile cancer during 1979-2009. Age-standardized incidence rates increased by 21 %, from 1.10 to 1.33 per 100,000. Mortality rates fell by 20 % after 1994, from 0.39 to 0.31 per 100,000. Survival analyses included 11,478 men diagnosed during 1971-2010. Five-year relative survival increased from 61.4 to 70.2 %. Five-year survival for men diagnosed 2006-2010 was 77 % for men aged under 60 years and 53 % for men aged 80-99 years. The 8 % difference in five-year survival (66-74 %) between men in the most affluent and most deprived groups was not statistically significant.
  
  
  CONCLUSIONS
  The 21 % increase in penile cancer incidence in England since the 1970s may be explained by changes in sexual practice, greater exposure to sexually transmitted oncogenic human papilloma viruses, and decreasing rates of childhood circumcision. Improvement in survival is likely due to advances in diagnostic, staging and surgical techniques. There is a need for public health education and potential preventative strategies to address the increasing incidence.
authors.affiliation: Department of Urology, University College Hospital, London, UK, manit_arya@hotmail.com.
authors.forename: Manit
authors.initials: M
authors.lastname: Arya
authors.forename: Ruoran
authors.initials: R
authors.lastname: Li
authors.forename: Kat
authors.initials: K
authors.lastname: Pegler
authors.forename: Vijay
authors.initials: V
authors.lastname: Sangar
authors.forename: John D
authors.initials: JD
authors.lastname: Kelly
authors.forename: Suks
authors.initials: S
authors.lastname: Minhas
authors.forename: Asif
authors.initials: A
authors.lastname: Muneer
authors.forename: Michel P
authors.initials: MP
authors.lastname: Coleman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D010412:Penile Neoplasms / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors